Provider Demographics
NPI:1255729802
Name:CARROLL, ANNA (NP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 EXPRESSWAY DR N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5301
Mailing Address - Country:US
Mailing Address - Phone:631-435-0110
Mailing Address - Fax:631-435-4582
Practice Address - Street 1:3001 EXPRESSWAY DR N
Practice Address - Street 2:SUITE 104
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5301
Practice Address - Country:US
Practice Address - Phone:631-435-0110
Practice Address - Fax:631-435-4582
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF306998-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology